Shoham Shmuel, Batista Carolina, Ben Amor Yanis, Ergonul Onder, Hassanain Mazen, Hotez Peter, Kang Gagandeep, Kim Jerome H, Lall Bhavna, Larson Heidi J, Naniche Denise, Sheahan Timothy, Strub-Wourgaft Nathalie, Sow Samba O, Wilder-Smith Annelies, Yadav Prashant, Bottazzi Maria Elena
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Médecins Sans Frontières, Rio de Janeiro, Brazil.
EClinicalMedicine. 2023 May;59:101965. doi: 10.1016/j.eclinm.2023.101965. Epub 2023 Apr 12.
The COVID-19 pandemic has disproportionately impacted immunocompromised patients. This diverse group is at increased risk for impaired vaccine responses, progression to severe disease, prolonged hospitalizations and deaths. At particular risk are people with deficiencies in lymphocyte number or function such as transplant recipients and those with hematologic malignancies. Such patients' immune responses to vaccination and infection are frequently impaired leaving them more vulnerable to prolonged high viral loads and severe complications of COVID-19. Those in turn, have implications for disease progression and persistence, development of immune escape variants and transmission of infection. Data to guide vaccination and treatment approaches in immunocompromised people are generally lacking and extrapolated from other populations. The large clinical trials leading to authorisation and approval of SARS-CoV-2 vaccines and therapeutics included very few immunocompromised participants. While experience is accumulating, studies focused on the special circumstances of immunocompromised patients are needed to inform prevention and treatment approaches.
新冠疫情对免疫功能低下的患者产生了尤为严重的影响。这类人群接种疫苗后反应不佳、发展为重症、住院时间延长以及死亡的风险更高。淋巴细胞数量或功能存在缺陷的人群，如器官移植受者和血液系统恶性肿瘤患者，面临的风险尤为突出。这类患者对疫苗接种和感染的免疫反应常常受损，使他们更容易出现长时间的高病毒载量以及新冠严重并发症。而这些反过来又对疾病进展和持续时间、免疫逃逸变异株的出现以及感染传播产生影响。目前普遍缺乏指导免疫功能低下人群疫苗接种和治疗方法的数据，这些数据多是从其他人群推断而来。导致新冠病毒疫苗和治疗药物获批的大型临床试验中，免疫功能低下的参与者极少。虽然经验正在积累，但仍需要针对免疫功能低下患者的特殊情况开展研究，为预防和治疗方法提供依据。
